Claim Example: Cherry Eye in Koa, a Bulldog puppy

The English Bulldog is instantly recognizable by their wrinkly faces and barrel-chested physique. But, in the veterinary world, Bulldogs are notorious for their eye problems.

220px-Prolapsed_gland_of_the_third_eyelid Dewey and Koa, both English Bulldogs in Newcastle, DE, were no exception. Starting out with a corneal ulcer in March 2009, Dewey was the first to have troubles. By May, he underwent surgery to correct Cherry Eye (also known by the convoluted name of prolapsed gland of the third eyelid), a painful condition in which the third eye lid is prolapsed, forming a red bubble in front of the eye.

Later that year, Dewey became a big brother when Koa came home. But poor Koa wasn’t even four months old when he was diagnosed with his own case of cherry eye. So, in he went for his own corrective cherry eye surgery, and follow up treatments.

Dewey and Koa are now back to normal, happy and healthy bulldogs again.

Dewey: Total cost for Cherry Eye Surgery: $524.07
Annual Deductible remaining: $0.00*
10 % Co-pay: 52.41
Reimbursement: $471.66
*Dewey had already met his annual deductible with prior claims for illnesses

Koa: Total cost for Cherry Eye Surgery: $626.22
Annual Deductible remaining: $200.00
10 % Co-pay: 42.62
Reimbursement: $383.60

Details on Koa's claim:
This claim is pretty typical of many Cherry Eye correction surgeries in that the correction was done at the same time Koa was neutered. Since Koa's insurance policy does not cover neutering (but our optional wellness plan does), the anesthesia was proportioned to 75% cherry eye correction and 25% neutering and covered accordingly (highlighted below).

ITEM BILLED AMOUNT ALLOWABLE CHARGES COVERAGE TYPE COVERED IN POLICY? COVERED CHARGES
Triple Antibiotic Eye Ointment  $ 13.44  $     13.44 IL Y  $    13.44
Additional Anesth. Maintenance/30 min.  $ 41.16  $     30.87 IL Y  $    30.87
Neuter Canine 21-40 lbs  $   195.00  $ 195.00 RC N  $   0.00
Hardarian Gland Tack  $   276.86  $ 276.86 IL Y  $ 276.86
Surgical Ophthalmic Pack  $ 30.76  $     30.76 IL Y  $    30.76
Inhalation Anesthetic Maintenance  $ 64.68  $     48.51 IL Y  $    48.51
Intravenous Induction  $ 25.87  $     25.87 IL Y  $    25.87
IV Catheterization-Surgical  $ 26.00  $     26.00 IL Y  $    26.00
Pain Management Injection  $ 19.93  $     19.93 IL Y  $    19.93
Pre Anesthetic Medication  $ 25.87  $     25.87 IL Y  $    25.87
Examination (Pre-Anesthesia)  $    0.00  $   0.00 IL Y  $   0.00
2.5 Novox 75 mg.  $ 17.55  $     17.55 DD Y  $    17.55
5 Tramadol 50 mg.  $ 17.55  $     17.55 DD Y  $    17.55
Soft Recovery Collar Canine 17 cm  $ 15.64  $     15.64 IL Y  $    15.64
Canine H3N8 Influenza Vaccine, 1st  $ 25.00  $     25.00 RC N  $   0.00
Tobramycin 0.3% Ophthalmic Soln 5 ml  $ 13.82  $     13.82 DD Y  $    13.82
Recheck Visit-Brief  $ 32.66  $     32.66 IL Y  $    32.66
14 Clavamox (Antibiotic) 125 mg.  $ 30.89  $     30.89 DD Y  $    30.89
 $   872.68  $ 846.22  $ 626.22

So the total claim reimbursement was $383.60, which is calculated below (this is the detail we send out in our explanation of benefits):

STEP 1: Calculate Potential Refund         
  Billed Amount:        $ 872.68
  Covered Charges:          $ 626.22
  Annual deductible remaining        $ 200.00
subtotal        $ 426.22
  Copay 10%  (your copayment)         $     42.62
Potential Refund         $ 383.60
                 
STEP 2: Compare potential refund against your annual maximums
Annual Maximum        $     10,000.00
Prior refunds for this policy year        $   0.00
Coverage remaining        $     10,000.00
     
Your total refund is:        $     383.60

Koa's policy ($200 annual deductible, 10% copay, $10,000 annual maximum, drugs and dental extension, no wellness coverage) costs $63.65 a month. Koa's premium is higher than many dogs because English Bulldogs have more hereditary conditions than most breeds, all else being equal.

Dr Janet Tobiasson Crosby will be writing more about Cherry Eye treatment and surgery in a blog entry next week.

Related Posts:
July is Eye Month at Embrace Pet Insurance
Claim Example: Cherry Eye in Koa, a Bulldog puppy
Cataract surgery claim example: Nala 2 yr old Papillon
Guest post: cherry eye treatment options
Guest Post: lens luxation in a Dalmation


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